Lower ED Margins Demand a Better Strategy

In this new Intelligence Report, we examine how resolving organizational problems in the emergency department will remain a challenge as demand for ED services increases, overcrowding elevates patient safety concerns, and quality metrics draw greater attention.

The emergency department continues to be challenged by its own internal problems even as it seeks to work with other hospital departments to overcome bottlenecks that can affect the efficiency and quality of patient care.

The results of the 2013 HealthLeaders Media Emergency Department Survey show that resolving these issues will remain an uphill battle as demand for ED services increases, quality metrics draw public attention, and ED overcrowding raises patient safety concerns. Reimbursement challenges and declining operating margins will further complicate matters.

Even as the healthcare industry transitions its delivery systems to emphasize patient-centered medical homes, care coordination, and the continuum of care, almost nine in 10 healthcare leaders (86%) expect their ED volumes to increase within the next three years.

It seems counterintuitive that demand for ED services is projected to grow just as millions of newly insured will enter the healthcare marketplace, but that has been the experience in Massachusetts where, in 2006, the state adopted a healthcare reform system that requires all residents to carry a minimum level of healthcare insurance.

Since then, ED volume across the state has "increased by about 1.5% annually," according to Assaad Sayah, MD, chief of emergency medicine at the three-hospital Cambridge (Mass.) Health Alliance. He notes that his own ED recorded 77,000 patients in 2005 (before Massachusetts healthcare reform), 98,000 in 2012, and is on track for 100,000 patient visits in 2013.

Sayah says physician shortages, especially in primary care, fuel much of the ED demand. "With healthcare reform, although the solution is to provide coverage for patients, the true solution is that there needs to be more patient access to primary care."